Immune Patterns in Pain Patients DSM-IV

Summary

The purpose of this study is to define subgroups of patients with somatoform disorders due
to DSM-IV by immunological, psychological and genetic characterization.

Description

Pain patients are defined as patients with a somatoform disorder due to DSM-IV, if chronic
pain lasts for at least 6 months in several anatomical regions. Somatoform disorders
(DSM-IV) have the presence of physical symptoms that suggest a general medical condition but
that are not fully explained by a general medical condition, by the direct effects of a
substance, or by another mental disorder. The symptoms must cause clinically significant
distress or impairment in social, occupational, or other areas of functioning. The physical
symptoms are not under voluntary control. Psychic factors exclusively or in combination with
a medical disease factor influence onset, severity, exacerbation or maintenance of symptoms
decisively. A subgroup of somatoform disorders, i.e., fibromyalgia, is a common nonarticular
rheumatic syndrome characterized by myalgia and multiple points of focal muscle tenderness
to palpation (trigger points). Muscle pain is typically aggravated by inactivity or exposure
to cold. This condition is often associated with general symptoms, such as sleep
disturbances, fatigue, stiffness, headaches, and occasionally depression. There is
significant overlap between fibromyalgia and the chronic fatigue syndrome. Fibromyalgia may
arise as a primary or secondary disease process. Interleukins IL-1ß, IL-6 und tumor necrosis
factor-a have been detected in the skin of these patients. Blockade of the 5HT3 receptor has
been reported to alleviate chronic pain in tendopathy, fibromyalgia and autoimmune diseases.
However, only a subgroup of patients responds to this therapy. It is supposed that patients
with somatoform disorders (DSM-IV) diagnosed according to clinical criteria consist of
immunologically heterogenous groups. However, up to now, the immunologic and genetic
background of patients with somatoform disorders classified via DSM-IV has not been
systematically evaluated. The study concentrates on the psychometric characterization of
patients with pain disorder focusing on depression, anxiety, coping behavior, psychic
trauma, alexithymia and somatoform symptoms. The present study is performed to define
subgroups of patients with somatoform disorders (DSM-IV) by immunological, pyschologic and
genetic characterization which may benefit from potential 5HT3 receptor antagonists or
anti-inflammatory therapy.

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Medical and Biotech [MESH] Definitions

Body Dysmorphic Disorders

SOMATOFORM DISORDERS characterized by preoccupation with some imagined defect in appearance not of delusional intensity but severe enough to impair social or occupational functioning. (American Psychiatric Glossary, 1994)

Somatoform Disorders

Disorders having the presence of physical symptoms that suggest a general medical condition but that are not fully explained by a general medical condition, by the direct effects of a substance, or by another mental disorder. The symptoms must cause clinically significant distress or impairment in social, occupational, or other areas of functioning. In contrast to FACTITIOUS DISORDERS and MALINGERING, the physical symptoms are not under voluntary control. (APA, DSM-IV)

Patient Health Questionnaire

A self-administered version of the Primary Care Evaluation of Mental Disorders (PRIME-MD), a diagnostic tool containing modules on multiple mental health disorders including anxiety, alcohol, eating, and somatoform modules. The Patient Health Questionnaire (PHQ-9) is designed specifically for mood/depression scoring each of the 9 DSM-IV criteria based on the mood module from the original PRIME-MD. The Generalized Anxiety Disorder scale (GAD-7) scores 7 common anxiety symptoms.

State in which an individual perceives or experiences a sensation of unreality concerning the self or the environment; it is seen in disorders such as schizophrenia, affection disorders, organic mental disorders, and personality disorders. (APA, Thesaurus of Psychological Index Terms, 8th ed.)

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